It takes more than a little courage to come forward with complaints that the
medical community does not yet see as standard. If those complaints are sexual
in nature, it is surely even more difficult to continue to address the subject
and ask the medical community to listen and respond. But for some time, brave
women have come forward, one by one, complaining of changes in their sexuality
that they insisted could not be explained by the loss of their breast. Indeed,
both women with mastectomy and those with lumpectomy brought froth these
complaints.

Women receiving chemotherapy are aware of many transitional side effect they
may suffer (e.g. nausea and vomiting, hair loss, fatigue). However, there are
also sexual side effects often not discussed and sometimes irreversible.
Preliminary research suggest that some chemotherapeutic agents interfere with
the production of sex hormones. If the women with whom I've talked are a good
barometer, discussion of sexual matters, if any, is limited to the shutdown of
ovarian function and premature menopause as it relates to estrogen depletion,
resulting in traditional menopausal symptoms (including a negative impact on the
arousal phase of a woman's sexual response cycle). Rarely discussed with women
is the fact that functioning ovaries also produce another hormone essential for
normal sexual functioning. Often referred to as the male hormone, a small but
vital amount of testosterone is also synthesized by the ovaries. Research by
Kapland Owett suggest that a virtual lack of testosterone can be a dramatic
side effect of chemotherapy
[1]. This decrease brings with it a loss of sexual
desire and decrease in the ability to experience orgasm.

In a non random sample generating 63 quesionnaires returned to Linda Bloom, a
San Francisco, California psychotherapist and herself a breast cancer survivor,
all but one of the women reported a drop in the enjoyment level of their sexual
experiences, with 52 women convinced that their sexual symptoms were long-term
side-effects of chemotherapy (L. Bloom, unpublished data, 1994).

This information will come as no surprise to those women who have been speaking
out about the decrease in sexual interest and sexual pleasure they have felt
following chemotherapy. Many women relate that they have been told that these
sexuality changes they experience are all psychological. Certainly for many,
there is some psychological impact of the breast cancer on their relationships
that may need to be addressed. That in no way obviates the need to address the
very real organic impact that chemotherapy may have on sexual functioning.
Kaplan puts forth very clearly the combination of depleted estrogen and
testosterone may negatively affect all three phases of the sexual response
cycle: desire, arousal, and orgasm [2].

There is little information in the literature about this impact of androgen
(testosterone) depletion on sexual functioning for women with breast cancer, and
even less on how to remedy it. Although Kaplan notes that in some instances,
women are being offered small nonvirilizing doses of testosterone, she quickly
adds that this has not been well studied and that some specialists are
"reluctant to risk testosterone administration," fearing the unknown.

There is still much to learn. What percentage of women experience permanent
androgen depletion and under what circumstances? What can we learn about
long-term safety of "testosterone replacement therapy"? Are there other
medications that can effectively restore desire and capacity for orgasm? In
what ways can we assess the interface between the psychological determinants of
sexual difficulties for these women? In addition to finding answers to
questions such as these, it is essential that health care professionals inform
women about all potential risks and benefits of available treatment
alternatives, including the side effects.

As many women have said to me in one way or another, "It's great to know that
I'm not alone, to have it validated that something really is happening to my
body. But I wait for more." They, as we do, look to the horizon, to await
answers to the above questions and more -- answers that will help each woman
reach out and feel sexually alive again.